(November 21, 2008 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.

On a recent trip to Hong Kong, we met up with Professor Keith Dip-kei LUK, who is Chair Professor and Head of Department of Orthopaedics and Traumatology, Division Chief in the Division of Spine Surgery, at the University of Hong Kong Li Ka Shing Faculty of Medicine.

If I had Lower Back Pain

Lower back pain is a very common problem. Most people will experience back pain at some point in their lives. The most common misconception is that when you have back pain, a nerve is being pinched somewhere, but this is a major misconception. Most of the time, back pain due to other causes rather than a nerve being pinched. For example, it is caused by muscle strain or a ligament strain, and usually it is a soft tissue strain. This pain should go away in a few days’ time.

I would not be very worried if I had a back pain, particularly if I did something wrong that led to the pain. As long as there is no significant radiation of the pain going down the leg, I would just sit on it for a few days, and I would expect it to improve with time.

If the pain persists, or if you have additional problems (such as the pain going down the leg, or numbness, or weakness in your leg), then I think that is a sign that it may be time to see a physician.


What does a lower back exam consist of?

During the examination, your doctor will do a full physical examination of your back, and also a full neurological assessment in your legs. You should also be prompted to tell the doctor whether you have any problem with your bladder control, or your bowel control, whether you are feeling any numbness or weakness in your toes, things of this nature. In the course of this physical examination, the doctor should have a good sense of whether your pain is due to a local muscular strain in your lower back, or whether there is a nerve being pinched. If necessary, you may need further imaging studies like an X-ray, an MRI or even a CT scan. The decision to do imaging will depend very much on the initial finding of the physical examination.


How is back pain treated?

The management of back pain depends very much on the diagnosis. If it is due to a muscular strain, obviously this can be treated conservatively, and you would expect it to improve over a short period of time. You will need to do some maintenance exercise afterwards to keep your muscles strong and balanced.

On the other hand, if you have a diagnosis such as a herniated disc, where the nerve is being pinched, (this will also depend on how severe the pinch is) most patients will improve to a certain degree with conservative treatment. If there are persistent neurological deficits, then your doctor may advise you to undergo surgery. It is only after failure of conservative treatment that surgery should be considered. Not everybody will automatically need surgery from the start.


In Summary…

If I had a back pain after lifting a heavy object, I would just wait for a little while. I would take a little rest, but not for too long, and as soon as the pain becomes tolerable I would go back to my regular exercises. Swimming is a very good exercise, and I would want to do that. If the pain doesn’t go away, and if there are any additional symptoms (pain going down the leg, or there is pain, numbness, or weakness of the toes, etc) then I would go to a physician and if necessary, I may need further investigations, like imaging of the back, and if conservative treatment fails, then I may need to undergo surgery.